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Patient Forms

Schedule Your Visit

Patient Forms

Birth Certificate Application

Download

Death Certificate Application

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Standard Power of Attorney

Standard power of attorney for medical/school decision making.

Download

Release / Acquisition Form

Medical authorization for release/acquisition of patient information.

Download

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We provide healthcare services and resources in Christian County, Kentucky that are safe, supportive and affordable.

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  • Mon - Thur: 7:30am - 4:30pm
  • Closed for Lunch: 12:00pm - 12:40pm
  • Friday: 7:30am - 11:00am

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270-887-4160

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